Palliative ICU beds for potential organ donors: an effective use of resources based on quality-adjusted life-years gained

Nunnink, Leo and Cook, David A. (2016) Palliative ICU beds for potential organ donors: an effective use of resources based on quality-adjusted life-years gained. Critical Care and Resuscitation, 18 1: 37-42.

Author Nunnink, Leo
Cook, David A.
Title Palliative ICU beds for potential organ donors: an effective use of resources based on quality-adjusted life-years gained
Journal name Critical Care and Resuscitation   Check publisher's open access policy
ISSN 1441-2772
Publication date 2016-03
Sub-type Article (original research)
Open Access Status Not yet assessed
Volume 18
Issue 1
Start page 37
End page 42
Total pages 6
Place of publication Strawberry Hills, NSW, Australia
Publisher Australasian Medical Publishing Company
Language eng
Formatted abstract
Objective: To evaluate whether the admission of a palliative patient to the intensive care unit for end-of-life care and consideration of organ donation provides an equivalent net benefit in quality-adjusted life-years (QALYs) compared with the admission of a non-palliative patient for active management.

Design: Relevant publications from the period 1995–2015 were reviewed to estimate the mean QALYs gained from ICU admission of a critically ill patient and mean QALYs gained from transplantation of solid organs from an organ donor. Australian audit data were used to estimate the likelihood of a palliative patient admitted to the ICU progressing to organ donation. We calculated probabilities of each outcome and developed an algorithm to illustrate possible pathways for a patient who may progress to organ donation.

Results: A non-palliative ICU admission provides to the patient about 1.0 QALY per ICU bed-day. An ICU bed provided to a patient admitted to the ICU for palliation and consideration of organ donation results in 7.3 QALYs gained for the community per ICU bed-day.

Conclusion: The admission of a dying patient to the ICU when organ donation may be possible is of considerable community benefit, yielding an average of over seven times the QALYs per ICU bed-day compared with the average benefit for ICU patients expected to survive. When it is possible to offer end-of-life care in the ICU, it should not be denied on the basis of concerns about lack of benefit or inappropriate use of resources.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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